不同Risser征定义对女性青少年特发性脊柱侧凸生长潜能评估的比较

Value of different Risser grading systems in determining growth potentiality of girls with adolescent idiopathic scoliosis

目的通过评价髂软骨的增殖活性，比较Risser征的美国方法和法国方法评估女性青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）生长潜能的价值。方法选择需要行后路脊柱侧凸矫形并取髂骨植骨的女性AIS患者，在前后位骨盆X线片上按照美国方法和法国方法读取Risser征，在患者髂软骨组织切片上对其增殖活性进行组织学分级（histologic grades，HGs）。分析两种Risser征的一致性，并比较两者与HGs的相关性。采用受试者工作特征（receiver operating characteristic，ROC）曲线方法寻找判断患者生长成熟的最佳参数。结果共收集有效标本53份，患者平均年龄14．0岁。两种Risser征的一致性较低，Risser征美国方法与HGs的相关性较好。Risser征美国方法5级或法国方法4级的患者髂软骨无明显增殖活性，提示生长停止；此外年龄〉16岁或月经年龄≥3岁亦提示生长停止。根据ROC曲线分析，将上述参数结合发现Risser征美国方法4-5级且月经年龄≥2岁亦可用于判断生长停止，该方法特异性为100％，准确度亦较其他单个参数高；该方法确定患者生长停止时平均年龄为15．2岁，较其他方法提前0．9-1．4岁。结论Risser征美国方法更适用于评估女性AIS患者的发育成熟情况；其与月经年龄结合应用可提高判断患者生长停止的准确度，且有助于提早支具治疗停止的年龄。

Objective To analyze the differences of United States （US） and France （Fr） Risser grad- ing systems in determining the growth potentiality of girls with adolescent idiopathic scoliosis （AIS）. Methods Girls with AIS undergoing posterior spinal correction with autogenous hone graft were recruited. The Risser grades were recorded for the non-dominant side iliac crest apophysis according to the US and Fr grading sys- tems. Iliac crest cartilage biopsies were harvested during surgery then standard histologic grades （HGs） of proliferation activity of iliac cartilage were analyzed on histological section. The agreement of two grading systems was analyzed by kappa statistics while the correlation between Risser grades and HGs were analyzed by Spearman correlation analysis. Receiver Operating Characteristic （ROC） curve was employed for selecting the best parameter in determining growth cessation of girls with AIS. Results Fifty-three AIS girls with an average age of 14.0 years were recruited. The agreement of two grading systems was poor. The US system showed higher correlation with HGs compared to Fr system. Growth cessation could be determined by Risser grade 5 of US system or Risser grade 4 of Fr system, also older than 16 years or three years after menarche. When combining the results of ROC curve analysis, the Risser grade 4-5 of US system with two years after menarche could be used in determining growth cessation with the highest sensitivity, specificity and accura- cy. Furthermore, the mean age of patients with growth cessation determined by this method was 15.2 years, showed 0.9-1.4 years earlier than the age determined by other methods. Conclusion The US Risser grading system is better in determining maturity of AIS girls compared to Fr Risser grading system. By combining years since menarche, the accuracy of Risser grades in determining growth cessation could be enhanced, and the time of weaning from a brace could be advanced.